Breathing Space – How step-down beds in City & Hackney are being used to address challenges of inpatient flow and private bed use

By Miles Tringham, Improvement Advisor

Leaving an inpatient hospital setting is a challenging time; needing to balance recovery, support, and getting back to independence. Unfortunately, some people stay on wards longer than planned because they have nowhere else to go. These social needs become a bottle neck in the system, causing a knock-on effect on the care we can provide others. Teams have been working hard to reduce the costly use of private beds, and create a better patient journey to meet the complex needs of individuals in their recovery.

Currently, too many people are awaiting discharge from the wards. The percentage of patients that are clinically ready for discharge (CRFD) has risen along with case complexity and acuity.

In October 2023 City & Hackney launched a new programme aimed at supporting patients who are clinically ready for discharge from inpatient wards but lack suitable accommodation to return to. This initiative involves the use of “step down beds,” which provide short-term accommodation and support for 2-4 weeks. The goal is to help individuals transition smoothly from inpatient wards to the community by addressing their social needs, such as housing.

Step-down beds offer daytime care in a temporary housing set-up, with support from discharge and community teams that includes the expertise of occupational therapists, nurses, social workers, and support workers. Patients get help with medication monitoring and support with paper-work and applications for future residencies. This approach not only aims to facilitate earlier discharge from hospital but also helps reduce the length of stay on acute mental health wards. It supports patients in reintegrating into the community in a safe and supported manner. Each step-down bed is a self-contained set up, providing a starter kit to help people be self-sufficient whilst living there.

“The step-down beds provide a ‘breathing space’ in the system for staff and service users” one team lead says. It alleviates some demand pressure off the acute wards, and provides a more practical, recovery-based intervention. “It’s been very well received by our patients. Sometimes the challenge is that people don’t want to move on from the set-up!”

This service is designed to provide a recovery-focused environment where residents receive assistance with daily living activities and any social or practical needs they may have. It’s a significant step towards ensuring that patients receive the necessary support to transition back to their communities successfully, without the need for readmission.  

The Importance of Planning

The key to the programme’s current and future success is thorough multi-disciplined discharge planning. Before using a step-down bed, the team is already planning about how they can meet the needs of the service user to discharge back into the community. “A step-down bed is just… the next step. The patient journey doesn’t end once they are off the ward. We are not the same as temporary accommodation. It’s vital that all staff understand the nature of the service, otherwise it doesn’t work” – Team lead.

Private bed usage and cost savings

Beyond the improvements to the patient journey, it also helps us reduce our private beds use. It’s an opportunity to move people placed out of area back out of private beds. “In some cases, I’ve been able to get patients out of private beds up to a month earlier than I think I otherwise would have” – Claire Richie, C&H Modern Matron. So far 9 people have been moved out of private beds into ‘step-down’. Many of these cases were the costliest uses of private beds.

This year, spending on private beds has seen immense improvement.